Practice Of Group Psychotherapy Research Articles

Personal Accounts: Stepping Into a Crosswalk

Personal Accounts: Stepping Into a Crosswalk

Introduction to the Special Issue

GROUP, Vol. 35, No.4,Winter 2011 Introduction to the Special Issue JohnCaffaro1 Ithas takenmanyyearsforourfieldto understand whatsiblings meanto one another. Morethan65years(roughly 1890-1955) passedbefore themodernfield ofpsychotherapy acknowledged thefullimpact ofthefamily onthedevelopment oftheindividual, although references tofamily influence werealways present in thepsychoanalytic literature. Oncefamily therapy begantomakeheadway, itwas almost another 30years (1955-1982) before theimportance ofsibling relationships wasmorefully developed byBankandKahn(1982). Specific references totheimportance ofsibling relationships anddynamics tothe theory andpractice ofgrouppsychotherapy weresimilarly absent from theliterature . A comprehensive search ofthecontents oftheInternational Journal ofGroup Psychotherapy from theyear1980through 2003revealed onlyfour articles directly related tosibling issues.Oneofthoseearly papers(Rabin, 1989)hasbeenreprinted with permission inthisvolume. I willsaymoreaboutthisseminal paperlater. A bodyofliterature hasemerged overthepast30years that provides clearand convincing evidence that brothers andsisters havea majorinfluence onhuman development andbehavior (Bank& Kahn,1997; Brody, 1996;Caffaro & Conn-Caffaro, 1998; Dunn,1988; Schachter & Stone, 1987; Whiteman & Christiansen, 2008).Despite this knowledge, a prevailing buterroneous biasthat parents andpeersmatter more continues tokeepsiblings andsibling dynamics ingroups invisible. Fewgraduate programs inclinical psychology orsocialworkoffer substantive training inadult sibling dynamics. Asa result, many group psychotherapists areunderprepared tohelp group members copewith thecomplexities oftheir bondswith sisters andbrothers. Nonetheless, clinicalexperience suggests thatsibling issuesregularly ariseinthe 1 Distinguished Professor, California School ofProfessional Psychology, Alliant International University, Los Angeles, and private practice, DelMar, California. Correspondence should beaddressed toJohn Caffaro, PhD, California School of Professional Psychology, Alliant International University, LosAngeles, CA91803, E-mail: jcaffaro@alliant.edu. ISSN 0362-4021©2011 Eastern Group Psychotherapy Society 273 274 CAFFARO practice ofgrouppsychotherapy. Grouptherapy offers anarray ofpossibilities for clients tointeract with leadersandmembers asthey onceinteracted with brothers andsisters. Sibling re-creations orfrozen roles, whenchallenged andconstructively addressed, provide group members with opportunities for increased awareness and for experimentation withnewbehavior (Caffaro & Conn-Caffaro, 2003). There aretwoaspectsofbeinga sibling that havedoggedtheliterature andtoo easilyconjured up rigidandfixed associations aboutourfield ofinquiry: rivalry andbirth order. Thebirth order hypotheses fuel popular assumptions aboutsibling rolesandbehaviors (e.g.,oldersaremoreresponsible andconventional, whereas youngers often becomerebels andhavemorefun)andalsoreducethecomplexity ofsibling relations tosometimes unrecognizable proportions. Important contextual variables, suchasgender, ethnicity, culture, andthefunctional rolea childoccupies ina family, getlostordiminished intheprocess. Thediscovery that siblings experiencetheir livesdifferently, though they areraisedinthesamefamily environment, highlights theimportance ofattending toeachgroup member sindividual reaction togroup events. Sibling experiences mayvary greatly, buttheevidence isclearthat sibling relationships matter a great deal.According toanearly longitudinal study ofsuccessful, well-educated men(including theHarvard classesof1938-1944), the single bestpredictor ofemotional health atage65years washaving a closerelationshipwith onessibling incollege; this wasmore predictive thanchildhood closeness toparents, emotional problems inchildhood, orparental divorce - more predictive, even,thanhaving hada successful marriage orcareer (Vaillant, 1977). Thisissueofthejournal begins with anearly article exploring theneglect ofpeer and sibling transferences in analytic grouptherapy byHerbert M. Rabin(1989). Theauthor usescaseexamples toexplore therichness ofworking through peerand sibling transference material ingroupwork. Asa supervising analyst overseveral decades,Rabinmakesthediscovery thatmosttherapists aremuchmoreattuned tothehistory ofthepatients relationship tohisorherparents thantohisorher relationships tosiblings andpeers.His efforts toaccountfor whythismaybe the case inevitably leadhimdirectly toFreud.Rabinunderscores theimportance of Freudsthinking regarding siblings andpeersas secondary actors withsuperficial rolestoplayinthedramaofthepatients narrative. ForFreud, everything points to either oedipal(three-person) orpreoedipal (two-person) dynamics. Rabinsetsoutto examinetheclinicalutility ofFreudshypothesis through exploration ofa groupcaseexample. Hisfocusonthefundamental importance of sibling dynamics intheworking through oftransference material for several patients demonstrates thevitality ofhisapproach. Rabinconcludes thatrather thanviewingpeerandsibling grouptransferences as derivative (ordefensive), they should beconsidered as sometimes central intheir ownright, with their ownexplanatory power.Thepoweroftheseearlyinsights has had considerable influence on the training anddevelopment ofa newgeneration ofgrouptherapists. Henceweare Introduction tothe Special Issue 275 pleasedto havetheRabinarticle serveas an important historical reminder and stimulus for thisspecialedition ofthejournal. Nextis Eva D. Papiasvilis"Sibling Transference Phenomenain Experiential ProcessGroups," which, building on Rabinswork, suggests thatsibling transferencescan also be manifested towardthegroupleader-therapist ortowardthe group-as-a-whole. Papiasvili, in herreviewoftheanalytic literature, notesthat, recently, Mitchell (2003)andVivona(2010)haveattempted toposita newspatial metaphor, addingthelateral (sibling) dimension tothevertical (parent-child) one astwointersecting challenges ofdesire andidentity. Sheexplores anddeepensour understanding oftherichness ofsibling transferences byreferring tothecontemporary analytic literature (Balsam, 1988; Des Rosiers, 1993; Vivona, 2010)addressing important distinctions between siblingderived parental transferences andsibling transferences intheir ownright, suggesting thattheformer reflects a pressure by thepatient tobeseenasa better sibling, whereas thelatter conveys competitiveness, specialunderstanding, andsolidarity. In "Family Systems Practicein Residential HealthCare:A Case forUsinga Sibling-Informed GroupIntervention," SusanRegas, RondaDoonan,John Caffaro, andJohn Bakaly takea family systems approach togroup intervention andexplore theremarkable impact that thedeath ofa child hasonthestaff ofa residential facility designed toprovide careforfamilies witha childsuffering from a critical illness. Thestrong emotions activated inresidential caregivers related tobothcurrent attachments andunresolved previous lossareheldinsharp relief under thetraumatic stress associatedwiththedeathofa child.Theauthors, as family psychologists, further...

The Therapeutic Relationship and Borderline Personality Disorder

International Journal of Therapy and RehabilitationVol. 18, No. 7 EditorialThe Therapeutic Relationship and Borderline Personality DisorderLeigh WrightLeigh WrightSearch for more papers by this authorLeigh WrightPublished Online:16 Aug 2013https://doi.org/10.12968/ijtr.2011.18.7.360AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Ball JS, Links PS (2009) Borderline personality disorder and childhood trauma: evidence for a causal relationship. Curr Psychiatry Rep 11(1): 63–8 Crossref, Google ScholarBennett D, Parry G, Ryle A (2006) Resolving threats to the therapeutic alliance in cognitive analytic therapy of borderline personality disorder: a task analysis. Psychology and Psychotherapy: Theory, Research and Practice 79(3): 395–418 Crossref, Google ScholarBohart AC, Elliot R, Greenberg LS, Watson JC (2002) Empathy. In: Norcross JC, Psychotherapy Relationships that Work. Therapist Contributions and Responsiveness to Patients. Oxford University Press, New York Google ScholarCastonguay LG, Constantino MJ, Holtforth Grosse M (2006) The working alliance: Where are we and where should we go? Psychotherapy: Theory, Research, Practice, Training. 43(3): 271–9 Crossref, Google ScholarCoid J, Yang M, Tyrer P, Roberts A, Ullrich S (2006) Prevalence and correlates of personality disorder in Great Britain. Br J Psychiatry 188: 423–31 Crossref, Google ScholarFallon P (2003) Travelling through the system: the lived experience of people with borderline personality disorder in contact with psychiatric services. J Psychiatr Ment Health Nurs 10(4): 393–401 Crossref, Google ScholarFonagy P, Bateman WA (2005) Attachment theory and mentalization-oriented model of borderline personality disorder. In: Oldham JM,Skodol EA,Bender DS, The American Psychiatric Publishing Textbook of Personality Disorders. American Psychiatric Publishing Inc, Arlington Google ScholarHaugh S, Paul S (2008) The Therapeutic Relationship Perspectives and Themes. PCCS Books, Herefordshire Google ScholarHolm AL, Serverinsson E (2008) The emotional pain and distress of borderline personality disorder: a review of the literature. Int J Ment Health Nurs 17(1): 27–35 Crossref, Google ScholarHorvath AO, Bedi RP (2002) The alliance. In: Norcross JC, Psychotherapy Relationships that Work. Therapist Contributions and Responsiveness to Patients. Oxford University Press, New York Google ScholarLevy KN, Clarkin JF, Yeomans FE et al. (2006) The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy. J Clin Psychol 62(4): 481–501 Crossref, Google ScholarLivesley JW (2004) Changing ideas about the treatment of borderline personality disorder. J Contemp Psychother 34(3): 185–92 Crossref, Google ScholarMartin DJ, Garske JP, Davis MK (2000) Relation of the therapeutic alliance with outcome and other variables: a meta-ana-lytic review. Consult Clin Psychol 68(3): 438–50 Crossref, Google ScholarMcMurran M, Huband N, Overton E (2010) Non-completion of personality disorder treatments: a systematic review of correlates, consequences, and interventions. Clin Psychol Rev 30(3): 277–87 Crossref, Google ScholarMeissner WW (2007) Therapeutic alliance: theme and variations. Psychoanal Psychol 24(2): 231–54 Crossref, Google ScholarNational Institute of Health and Clinical Excellence (2009) Borderline Personality Disorder: Treatment and Management. A Quick Reference Guide. NICE, London. www.nice.org.uk/CG78 Google ScholarSafran JD, Muran CJ, Wallner Samstag L et al. (2002) Repairing alliance ruptures. In: Norcross JC, Psychotherapy Relationships that Work. Therapist Contributions and Responsiveness to Patients. Oxford University Press, New York Google ScholarStraussner SLA, Phillips NK, (2005) The role of empathy in work with women offenders. Int J Prison Health 1(2-4) 255–62. Crossref, Google ScholarYalom ID, Leszcz M (2005). The Theory and Practice of Group Psychotherapy. 5th ed. Basic Books, New York Google Scholar FiguresReferencesRelatedDetailsCited byThe Norwegian version of the Scale To Assess the therapeutic Relationship (N-STAR) in community mental health care: Development and pilot study7 May 2015 | International Journal of Therapy and Rehabilitation, Vol. 22, No. 5 1 July 2011Volume 18Issue 7ISSN (online): 1759-779X Metrics History Published online 16 August 2013 Published in print 1 July 2011 Information© MA Healthcare LimitedPDF download

Coming to Our Senses: The Application of Somatic Psychology to Group Psychotherapy

Somatic psychology, the interplay of the body, the mind, the emotions, and the social context, significantly contributes to the theory and practice of group therapy. The processing of sensory experiences in the here-and-now of the therapy group helps group members to develop self-awareness, the ability to understand their relationships with others, and the capacity for empathy. When group members know what they experience, they can understand how others feel and resonate emotionally with those feelings. Neurobiology, sensory processing, and attachment theories help us to understand how the sense of self develops somatically. Principles of somatic therapies are applied to group therapy practice in working with attachment disorders, transference impasse, and trauma. The importance and implications of the group therapist’s embodied attunement are explored.

Power of Love and Love of Power in Group Psychotherapy

This article continues to explore some crucial differences between group analysis (as a western approach to group therapy) and the Minia integrative dynamic model (an approach that was developed in Egypt in the last decade). The article re-emphasizes the assumption that certain socio-cultural factors can grossly affect both the theory and practice of group psychotherapy; so, what can work for western therapists/patients is not necessarily supposed to work for eastern therapists/patients. The article also explores the meaning and power of love in both models of group therapy according to different perceptions, understanding and the functioning of love in different cultures.

Evidence‐based group psychotherapy: using AGPA's practice guidelines to enhance clinical effectiveness

Practice guidelines represent a useful approach to facilitate the delivery of evidence-based mental health care. In this article, we detail group psychotherapy practice guidelines developed by the American Group Psychotherapy Association (AGPA). Combining the research literature with expert consensus, the AGPA has created a resource that should prove useful for psychotherapists, administrators, and patients. We illustrate the guidelines through a series of clinical dilemmas and challenges.

Contribuições da poética social à pesquisa em psicoterapia de grupo

Esse artigo tem por objetivo apresentar algumas contribuições do construcionismo social e da poética social ao entendimento da psicoterapia de grupo e de sua investigação científica. O construcionismo social se define como uma forma alternativa de inteligibilidade em ciência, que privilegia a compreensão do modo como as pessoas constroem sentidos sobre o mundo e sobre si mesmas em suas práticas discursivas. Coerente com essa perspectiva, a poética social caracteriza uma prática de pesquisa útil à investigação dos processos conversacionais, enfatizando a centralidade do pesquisador na construção de sentidos sobre seu objeto de estudo. Nesse artigo, buscamos demonstrar como estas perspectivas podem sustentar uma prática sistemática de pesquisa sobre a psicoterapia de grupo. Para tanto, apresenta os passos metodológicos desenvolvidos em um estudo acerca de um grupo em saúde mental, demonstrando como esses permitiram compreender o processo conversacional por meio do qual o próprio grupo se constituiu como um recurso terapêutico.

Coping with the Stress of Urban Living in the Urban Millenium: Ayo Binitie and Current Perspectives*

Urban areas within a country are defined as towns with the highest population density. By mid-2007, the world entered the urban millennium, because for the first time in history, over 50% of persons live in urban areas. The major source of urban stress is overcrowding and consequent environmental pollution ( noise, fumes, refuse) and traffic congestion, which are stressful. Problems associated with urban slum dwelling places include poverty, homelessness, crimes, violence, drug addiction, and sexual abuse. Cities usually fail in their primary duty of providing employment and accommodation for a sufficient number of the teeming migrants. There is increased risk for schizophrenia and depression among urban residents. Hence, urban living is associated with enhanced opportunities for encountering distressing experience. Yet, the city is always a hotbed for new ideas, for modernity, for social networking, and national economic development. The concept of stress concerns the effects of psychosocial and environmental factors on physical and mental well-being. Developments in the psycho-biology of stress include the following concepts: the stress (fight-or-flight) response, the role of glucocorticoids in the hypothalamo- pituitary-adrenal axis, the relaxation response, allostasis, the broaden-and-build theory; as well as the current idea of endophenotypes that seeks to clarify our understanding of how gene-environment interactions mediate coping mechanisms, such as resilience, optimism, positive affect and benefit finding. It appears that those who are resilient to stress, who react with a larger positive affect, and who are optimistic, are likely to have the met/met polymorphism of COMT and BDNF, as well as ll (long) alleles of the serotonin transporter. Those who are vulnerable to decompensate into depression or schizophrenia in the face of stress are more likely to have the val/val (for COMT and BDNF) and ss (for 5HTTLPR) polymorphisms. Ayo Binitie appreciated these ideas in his theories about stress (the “pulley paradigm” and “group focal theory”), in the classification that he proposed for stress- related disorders (disorders of social living), in his practice of group therapy and psychotherapy through environmental manipulation, and his faith in the physical fitness culture for which he was an exponent. The Uselu Therapeutic Neighborhood, which he established, bore the hall marks of his social conscience and practical innovativeness. As an urbanite, he taught us how to overcome the stresses of urban life and enjoy the city fully. Nigerian Journal of Psychiatry Vol. 6 (1) 2008: pp. 4-9

The Edge of Chaos: Enactment, Disruption, and Emergence in Group Psychotherapy

The author outlines his approach to the theory and practice of group psychotherapy. The emphasis is on therapy by the group rather than therapy in the group. The therapist's task is to help the group itself become the agent of change. The group is conceived as being composed of many multiple selves. The process of group psychotherapy unfolds through enactments that involve the whole group and the group therapist entering into the grip of repetitive and unmentalized self-states. These enactments are resolved when the group members, with the therapist's help and containment, can access alternative self-states that allow for new and unformulated experience to emerge. This dialectical movement between the rigid “familiar chaos” of enactment and the reflective and related working through is compared to the dynamic systems theory articulation of the tension between rigidity and chaos captured by Kauffman's notion that “life exists at the edge of chaos.” A group session is described that involves a painful enactment. It illustrates how the therapist allows the enactment to unfold by holding and containing intense affect and how the group members are helped to find their own meaning and new experience in interaction with each other.

The Ethical Group Psychotherapist: A Coda

This concluding article of a two–part special section on the ethical group psychotherapist are highlighted: (1) the importance of the cultivation of the skill and knowledge base of the group psychotherapist in terms of pertinent legal statutes and ethical guidelines; (2) the criticalness of certain personality features related to the concept of virtue; (3) a therapist’s self–awareness contributes to the capacities to think and respond ethically; (4) ethical decision making is most likely to occur when the group psychotherapist attends comprehensively to all dimensions that define the setting in which a dilemma emerges; and (5) that in the service of positive ethics, attention to the ethical dimensions of group psychotherapy practice should be continuously present. In agreement with other contributions to this section, I conclude that the commitment to the ethical practice of group psychotherapy must be made not only by the individual practitioner but also by educational and training programs and professional organizations.

Informed Consent in the Practice of Group Psychotherapy

Endorsed as part of ethical practice in group psychotherapy by professional organizations, informed consent is a process of communicating essential information about group treatment to patients so that they can make rational decisions about treatment-whether to enter and how to participate. Its benefits as well as necessary precautions are discussed. The design and implementation of the informed consent process for group is discussed in terms of who should obtain it, when it should occur, how it should be communicated, and what information should be considered for inclusion. Specific suggestions are included as well as a discussion of some potential ethical dilemmas.

O terapeuta na psicoterapia de grupo

Psicoterapia de grupo designa, atualmente, um amplo espectro de procedimentos fundamentados nos mais variados referenciais teóricos, aplicados em diferentes contextos. O objetivo do presente estudo é abordar o papel do terapeuta de grupo, delineando algumas estratégias e habilidades necessárias para o exercício da grupoterapia. Os autores enfatizam o nível técnico-científico em que o trabalho com grupos é desenvolvido e a influência da personalidade do terapeuta nos participantes. Concluem que, para que o terapeuta possa preservar seu papel, sem perder a especificidade de sua função por envolvimento com as múltiplas situações vividas com os pacientes, é fundamental a estabilidade de sua identidade profissional. Nesse sentido, o preparo do terapeuta, a partir de seu processo de formação continuada, é condição necessária para habilitá-lo a enfrentar as situações peculiares do contexto grupal, de modo a conferir à psicoterapia de grupo seu singular potencial terapêutico.

Commentary on “Therapist-Initiated Termination”

Therapist-initiated termination poses several unique problems for both the group and the therapist. This paper describes the termination process from the point of view of this therapist's experience in planning the termination of her group therapy practice. The reactions of other analysts to her decision to retire and the group processes and individual patient's reactions in this long-term psychoanalytic therapy group are described in detail. The author follows the group process and her own inner processes in the final six months of the group. The importance of the working through of the termination phase of therapy is supported by the experiences that were shared by the group and the therapist.

When the Therapist Says Goodbye

Therapist–initiated termination poses several unique problems for both the group and the therapist. This paper describes the termination process from the point of view of this therapist’s experience in planning the termination of her group therapy practice. The reactions of other analysts to her decision to retire and the group processes and individual patient’s reactions in this long–term psychoanalytic therapy group are described in detail. The author follows the group process and her own inner processes in the final six months of the group. The importance of the working through of the termination phase of therapy is supported by the experiences that were shared by the group and the therapist.

Sibling Dynamics and Group Psychotherapy

The role of sibling dynamics in group psychotherapy has received relatively little attention in the literature. Our clinical experience suggests that sibling issues regularly arise in the practice of group psychotherapy. This article provides an integrative view of sibling relationships from a family systems and self psychology orientation to group therapy. Special emphasis is placed on developmental and cultural differences as they affect sibling dynamics and the group leader’s role. A number of case examples are offered to illustrate ways to view clinical challenges in a manner consistent with the influence of sibling relationships on group members and group process.

Psychothérapies de groupe : étude exploratoire en Suisse

The objective of this study is to examine the different forms of group psychotherapy practices in Switzerland and their underlying theoretical orientation. Materials and methods – Data was collected by means of a questionnaire sent by post to psychiatrists and psychologists. Analysis covers the answers of 533 therapists practicing group psychotherapy. Results – Groups are, in the majority, small in size and they deal mainly with adults. A classification based on the theoretical orientations underlying practice revealed five types of groups: a psychodynamic, a systemic and a cognitive-behavioral based type; a more heterogeneous type comprehends different humanist approaches; a composite type includes groups with multiple theoretical references and represents 40 % of the entirety. Conclusions – This study, although not exhaustive, reveals notable aspects of group psychotherapy practice, in particular the important place taken up by multiple theoretical orientation. This type of practice questions the meaning of eclecticism among therapists: model mix-up or necessity? Factors that intervene in the choice of theoretical orientation are discussed: this choice can be linked to therapists’ characteristics and experience, but other factors, related to economical and social mechanisms, could play a preponderant role in the future.

Introduction to the Special Edition: The Implications of Multicultural Diversity and Ethnopolitical Conflict for Working with Groups

This introduction to a special edition of the journal Group on “The Implications of Multicultural Diversity and Ethnopolitical Conflict for Working with Groups” explores the reasons that social and political forces and traumatic societal events have until recently been neglected in the theory and practice of group psychotherapy. Freud's abandonment of the infantile seduction theory and subsequent emphasis on intrapsychic fantasy and defense, the philosophy and science of the Enlightenment, and professional norms in a field dominated by individuals from “privileged” classes and cultures are cited as sources of the relative neglect of ethnopolitical conflict, minority issues, and multicultural diversity in the treatment process. The articles in this journal attempt to redress these shortcomings and constitute a movement towards including these factors in the common “standard” of training and treatment.

Culture and the Practice of Group Psychotherapy in Singapore

Trained in Foulkes’ group analysis (Foulkes, 1965) in London, the author, born and bred in Singapore, conducted a slow-open, multiracial psychotherapy group in the English language for neurotic patients in Singapore over an 8-year period. Thirty patients attended the group with an average attendance duration of 3 years. The majority had a favorable outcome with improved symptoms, interpersonal relationships, and ability at work. This article identifies a number of unique, culture-specific group processes in the following areas: authority, individuation, and intimacy. The relevance of Western group psychotherapy to Oriental culture will be also examined in light of the above group being the first, psychodynamic group-analytic group in Singapore.

The Yalom Reader: Selections From the Work of a Master Therapist and Storyteller

The Yalom Reader: Selections From the Work of a Master Therapist and Storyteller

A Retrospective of Group Therapy: A Letter

Dear Colleague: I am writing to you on this bitter, snowy December 20th, 2031 as I celebrate my 100th birthday. It has been 25 years since I discontinued my group psychotherapy practice and consultation. Here, in the home of my great grandchildren, before a crackling fire, I am taking a brief break from the festivities, and find myself reflecting on what has happened to group psychotherapy in this millennium. Certainly, I find that much easier than trying to predict the future. I first attempted to divine the future of group therapy 45 years ago (Stone, 1985). I had suggested that one change would be a rapid increase in the use of support groups—that prediction was accurate. For almost two decades advertisements and announcements of support groups for any and every known illness filled the media. However, anyone primarily wishing to learn about support for a psychiatric illness was first advised to consult the Internet for the extensive information about any of the diseases described in DSM IV – IX. We then passed through a period when cognitive knowledge was deemed to be sufficient support and with that notion, for a brief time, support groups nearly perished. But the urge for human contact prevailed and these groups experienced a flourishing renewal. Support groups are much more sophisticated now. At present, participants focus on examining the emotional impact of the illness upon themselves and their families. Nonprofessional leadership is provided in many settings by corporate and business managers who have become familiar with group dynamics. Indeed, all major corporations and most smaller businesses incorporate basic training in group dynamics for all levels of management, and these skills are assessed and valued as highly as those in finance and marketing. I was very pleased to see the expansion of group training to include